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Rajeev Jayadevan Profile picture
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19 May, 7 tweets, 2 min read
Multiple reasons for prolonged QT interval in COVID-19. (this brings on risk of abnormal heart rhythms) The disease itself (day 2 & 5 of hospitalization) can cause it, worse among older people. Azithromycin and HCQ are known to cause it.
See thread.
1/7
medscape.com/viewarticle/94…
Small, but significant increase in cardiac deaths among those who took Azithromycin (which can prolong QT interval). Must be cautious (& judicious) while prescribing it in patients with COVID-19, a condition which independently prolongs QT interval.

2/7
jwatch.org/na51857/2020/0…
Older people and those on multiple medications are more likely to have prolonged QT interval in COVID-19: Study from Toledo, Ohio.

(Not everyone with prolonged QT will develop an overt heart problem, but this is a flag for enhanced arrhythmia risk)

3/7
bmccardiovascdisord.biomedcentral.com/articles/10.11…
Case report from Spain on a 70-year-old man with COVID-19 who developed bradycardia (slow heart rate) and prolonged QT interval, likely multi-factorial.

4/7
escardio.org/static-file/Es…
Work from Columbia University New York demonstrating that COVID-19 is independently associated with prolongation of QT interval. The related MedScape article is on this thread.

5/7
jamanetwork.com/journals/jaman…
The above examples show the need for diligence while prescribing medications, & avoiding poly-pharmacy in COVID-19.

QT interval is not something that is routinely checked. Just because the patient "appears fine" it does not mean such events are not occurring in the body.

6/7
Sometimes, doctors claim "there is no harm in giving it, therefore why not prescribe?"

That is exactly the point here: not all patients are closely monitored after a prescription is written in an outpatient clinic. Hence, it is wrong to assume that "there is no harm".

7/7

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More from @RajeevJayadevan

Rajeev Jayadevan Profile picture
20 May
How many people are vulnerable to COVID-19 in India?

This is an audit of COVID-19 serology data from 448,518 samples by a private lab from 12 cities in India:

a) Overall, 31% tested seropositive for SARS-CoV-2 antibodies till December.

see thread 1/8

medrxiv.org/content/10.110… ImageImage
b) These were samples collected from self-referred people; from relatively higher socioeconomic class.

c)Their clinical detail is unknown.

d) 41% of those who tested in December were seropositive, up from 18% in July.

e)Faster rise in + rate in younger age groups (<44)

2/8
f)Different cities had different 'peak' phase of the pandemic e.g. Delhi had 2 peaks June & December; Chennai had one peak in July, Pune in September. Overall peak for India was mid September.

g)Pune had the highest: 69%. These 12 cities accounted for 1/3 of cases in India.

3/8
Read 8 tweets
Rajeev Jayadevan Profile picture
19 May
Profile of 18 neonatal COVID-19 patients from Mumbai, February 2021. 4 were preterm. Only 50% had COVID-positive mother/caregiver. Ventilation required for 6. Four were repeatedly test-positive, of whom 3 were critical on ventilator. Death occurred in 3.
iapindia.org/pdf/Indian-Ped…
Series of 3 neonatal COVID-19 from KEM hospital Mumbai. All had good outcomes. Remarkably, the NP swabs remained positive even in the 4th week in 2 of them, prolonged shedding is possible. This is consistent with impaired ability to clear the virus.

link.springer.com/article/10.100…
Large series of 182 neonatal COVID-19 from 20 Indian centres compiled by PGI Chandigarh finds neonates are more likely to be symptomatic (5x), have respiratory symptoms, & other neonatal morbidities. However, mortality is not increased significantly.
1/2
indianpediatrics.net/COVID29.03.202…
Read 4 tweets
Rajeev Jayadevan Profile picture
4 May
This thread is a classic example of personal bias overriding scientific temperament. >80% COVID-19 patients recover with no medication, but credit is given to drug given.

Bacteria, their benefits apart, do not require to be killed, unless they cause secondary infection.

🧵 1/4
Besides no one gives any journal the license to make guidelines. Peer reviewed journals hold a high standard of eliminating fraudulent claims and at this time, they are a relatively credible source of evidence. Whether we adapt from the paper depends on many factors.

2/3
For starters, never believe the conclusions of any research paper. As a doctor you must have the basic knowledge of biostatistics to look at the methodology, raw data, primary outcomes, confidence intervals and the merits of the tests of association they used.

3/3
Read 5 tweets
Rajeev Jayadevan Profile picture
4 May
The dubiously named “double mutant” has become “single” it seems.

Yes, the B.1.617 has lost one of the two mutations* E484Q and become B.1.617.2, which has more cases in UK than the original.

(*B.1.617 has ~13 mutations in fact; only L452R & E484Q received attention)

1/4
Total cases of “double mutant” B.1.617 in the UK is only 193, while its new “single version” B.1.617.2 already has 202 cases.

Losing the E474Q mutation (and ‘becoming single’) must’ve seemed a good thing for the virus.

2/4
health.economictimes.indiatimes.com/news/industry/…
Only B.1.617.1 and B.1.617. 3 have the E484Q mutation, while B.1.617.2 dies not.

Please note that E484Q isn’t the same as E484K, the latter has known immune escape properties.

3/4
Read 4 tweets
Rajeev Jayadevan Profile picture
4 May
Evidence based medicine is not being practised enough in India. Many "official COVID19 treatments" in India have already been discarded by the world, but patients still receive long lists of drugs that only add to cost & side effects.

1/10
scroll.in/article/993859… via @scroll_in
Chloroquine, Ivermectin, plasma, steam inhalation, 'coronil', azithromycin, doxycycline, oseltamivir, vitamin D (for people without proven deficiency), Zinc, vitamin C, PP inhibitors are still prescribed in India, despite lack of evidence. This is called polypharmacy.

2/10
"There is no harm in giving it" is not a scientific explanation that can justify irrational use. Besides, all harms need not be obvious to the prescriber.

Doctors are trained to use the minimum number, dose & duration of medication for any disease, and only if necessary.

3/10
Read 11 tweets
Rajeev Jayadevan Profile picture
4 May
Cell entry mechanisms of SARS-CoV2. Fusion peptide molecules in the spike protein need to undergo a conformational change ("bending") to help "clip" the 2 membranes together (virus & human cell);energy is needed to overcome a repulsive hydration force. 1/n
pnas.org/content/117/21…
The fusion process - or final conformational change- varies by availability of multiple cellular proteases, and may be facilitated by environmental factors (physical force/temperature/chemical) in addition to furin preactivation.

2/n
The SARS-CoV-2 virus is a 'more advanced model' than the original 2003 SARS virus, in that its RBD remains hidden (in lying down / 'off' position) helping it escape our immune surveillance.

While this might theoretically affect its ability to bind to the ACE-2 receptor,

3/6
Read 6 tweets

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